Healthcare Provider Details

I. General information

NPI: 1619258266
Provider Name (Legal Business Name): ROSA MARIA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 WHITTIER BLVD
PICO RIVERA CA
90660-2405
US

IV. Provider business mailing address

900 CORPORATE CENTER DR STE 350
MONTEREY PARK CA
91754-7620
US

V. Phone/Fax

Practice location:
  • Phone: 562-801-4626
  • Fax: 562-801-4630
Mailing address:
  • Phone: 323-526-4016
  • Fax: 323-526-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number79889
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: